Indiana Administrative Code
Title 470 - DIVISION OF FAMILY RESOURCES
Article 11.1 - HOSPITAL CARE FOR THE INDIGENT
Rule 4 - Hospital Care for the Indigent Payment Procedures
Section 4-2 - Payment of provider claims
Current through September 18, 2024
Authority: IC 12-13-2-3; IC 12-13-5-3
Affected: IC 12-16-7-4
Sec. 2.
(a) Upon receipt of the provider's "completed" and "approved" claim, the division or its designee shall pay two-thirds (b) of the "allowed rate" for said claim within a reasonable period after receipt thereof subject to the provisions of subsection (c).
(b) An "allowed rate" as used in this rule, means the current rate of reimbursement which a hospital would have received as a Medicaid provider at its "Medicaid interim rate" for having rendered the same service, or that rate of reimbursement which a nonhospital provider would have received as a Medicaid provider for having rendered the same service.
(c) In the event that funds allocated to pay claims for a given state fiscal year are insufficient to pay the two-thirds (b) of "completed" and "approved" claims submitted for that state fiscal year, the department's liability for further payment hereunder is limited to the provisions of IC 12-16-7-4(b).
(d) In the event that there are funds available at the end of each state fiscal year, the department shall, to the extent of such available funds, pay each provider a pro rata portion of the one-third (a) balance on paid claims at the allowed rate. The formula for such year end payments shall be:
| Total HCI funds available Total one-third (a) balance | × | Total amount of a provider's unpaid balance | = | Amount paid at fiscal year end to provider |
The numerator shall not exceed the dollar amount represented in the denominator.
